Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose–Response Meta-Analysis

Abstract

Excess alcohol consumption is known to be detrimental to human health. However, the role of light-to-moderate alcohol intake is under investigation for potential certain health benefits—mostly related to the cardiovascular system. Nevertheless, there is no univocal agreement on this matter, and research is still ongoing to clarify whether there might be other potential outcomes affected by alcohol intake. In this regard, there is evidence that excess alcohol intake may negatively influence the risk of osteoporotic fractures. However, there is no comprehensive evidence of literature assessing the role of alcohol consumption in bone mineral density (BMD) and the risk of osteoporotic fractures. Thus, the aim of this study was to quantitatively assess the dose–response relationship between alcohol intake and BMD and risk of osteoporotic fractures. The Embase and MEDLINE electronic databases were searched from their inception to December 2021 for articles providing a quantifiable measurement of alcohol consumption for at least three categories and (1) a measurement of BMD (and dispersion as continuous variables) in some area of the body or (2) risk of osteoporotic fracture provided as relative risk (RR) or hazard ratio (HR), with a 95% confidence interval (CI) as the measure of the association of each category with alcohol intake. A total of 11 studies including 46,916 individuals with BMD assessment and 8 studies including 240,871 individuals with risk of fracture analysis were included. Compared to non-drinkers, consumption of up to two standard drinks of alcohol per day was correlated with higher lumbar and femur neck BMD values, while up to one standard drink of alcohol was correlated with higher hip BMD compared to no alcohol consumption. Higher risk of hip fractures was found starting from three standard drinks of alcohol per day (RR = 1.33, 95% CI: 1.04; 1.69 for three alcoholic drinks/d, and RR = 1.59, 95% CI: 1.23; 2.05 for four alcoholic drinks/d) compared to no alcohol consumption, with no evidence of heterogeneity. Concerning the risk of any osteoporotic fractures, the risk steadily increased with higher intake of alcohol, although never reaching statistical significance. In conclusion, there is consistent evidence that increased alcohol consumption is associated with higher risk of osteoporotic hip fracture; however, the role of alcohol at lower doses is uncertain, as BMD was even higher in light drinkers compared to abstainers.

Effect of moderate beer consumption (with and without ethanol) on osteoporosis in early postmenopausal women: Results of a pilot parallel clinical trial

“…Fiber intake met the EFSA recommendations and alcohol consumption ranged from low to moderate. Calcium intake also met the recommendation for older people (750 mg/day) or was slightly below, whereas the intake of dietary vitamin D was below the level established for adults (600 IU/day or 15 µg/day) (41).…”

“…The effects of beer or specific beer components on BMD loss have been previously reported ( 22 ). Excessive alcohol consumption is associated with a higher risk of osteoporotic fractures ( 42 ) and an imbalance in bone remodeling, which becomes skewed toward bone loss ( 43 ). Beyond this well-documented association, the effects of moderate alcohol drinking on bone health have also been studied.…”

“…Beyond this well-documented association, the effects of moderate alcohol drinking on bone health have also been studied. A recent meta-analysis by Godos et al ( 42 ) found that up to two standard alcoholic drinks/day vs. alcohol abstinence are related with a higher lumbar and femoral neck BMD, while up to one standard drink/day was found to be associated with higher hip BMD ( 42 ). In the Framingham Offspring Cohort Study, the relationship between alcohol intake and BMD at three hip sites and the lumbar spine was analyzed in 1,289 postmenopausal and 298 premenopausal women ( 11 ).…”

“…Moreover, as pointed out by Godos et al ( 42 ), little evidence is available for the impact of variables such as age, the evaluated skeletal site, duration of exposure to alcohol, and the pattern of drinking ( 46 ). Discrepant results between studies on alcohol and bone health could be related to differences in factors such as age and gender.…”

“…were also monitored (Supplementary Table 2). Regarding the median dietary pattern of the participants, intake was low for carbohydrates (<45-60% kcal/total kcal) and high for sugar (>10% kcal/total kcal), protein (>12-15% kcal/total kcal), fat (>20-35% kcal/total kcal), and saturated fatty acids (<10% kcal/total kcal), according to the reference values of the European Food Safety Authority (41). Fiber intake met the EFSA recommendations and alcohol consumption ranged from low to moderate.…”